| NPI | 1588651525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME119317) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 225090-1) |
| 207L00000X Anesthesiology (Licence: OH 35082283) | |
| 207L00000X Anesthesiology (Licence: PA MD420149) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2019-03-21 |